Flashcards in Fungal Infections Part 2 Deck (26):
What are opportunistic molds?
they are ubiquitous. They are commonly found in the environment, air, soil and decaying matter. reproductive spores are routinely inhaled. they cause opportunistic infections.
Opportunistic molds are slow/fast growers?
fast. they can develop colonies in 3-5 days.
What is one of the most common opportunistic molds?
aspergillus species. (aspergillus fumigatus is one of the most commonly isolated species.
What is the allergic response to aspergillus?
allergic response to antigens: asthma, elevated IgE, eosinophilia
What is the upper resp. symptoms to aspergillus?
discharge, HA, facial pain
What is the obstructive bronchial aspergillosis and aspergilloma syndrome? (fungus ball)
bronchi become obstructed with mold. usually asymptomatic, and causes no additional symptoms. not treated.
Aspergillus can cause serious problems in those who are immunosuppressed, what are the problems?
can cause disseminated disease, usually WBC is below 500. Often involves lung, and can cause suffocation in the patient. Can also spread to brain, heart kidneys, GI, liver, and spleen. Prevention is filtering home air.
What is the stain to use for aspergillus sp fungal infections?
gomori methanamine silver stain (silver stain). will show dichotomous branching. Or you can use a calcoflour white stain (fluorescent stain).
How long will a fungal culture for aspergillus take to grow?
2-4 days. then confirmed by 7 days. can grow on routine bacterial media.
Is every aspergillus infection that grows on culture worth treating?
It depends. Factor in patient symptoms to decide if treatment is necessary. Not always needed.
What is the treatment for aspergillus?
surgery to remove if possible or antifungals: voriconazole and amphotericin B/
What is a dimorphic mold? What are two examples?
exhibits two morphological forms.
35 degrees = yeast phase (parastic phase)
22 degrees = mold phase (saprobic phase)
examples = histoplasma capsulatum and coccidiodes immitis.
They are inhaled and then disseminate to the lymph system and reticuloendothelial system.
Describe histoplasma capsulatum?
endemic to midwest, associated with bird and bat droppings. most cases are asymptomatic. The disease tends to progress in : children, immunocompromised, and lung disease. It can be reactivated in those who are immunocomprised (ex. Aids)
Are are the three infection states of histoplasma capsulatum?
Acute, Chronic and Systemic
Describe Acute histoplasma capsulatum
similar to TB: fever, weight loss, lymphadenopathy. self-limiting.
describe chronic histoplasma capsulatum
calcified nodes, chronic cavitary disease, granulomas
describe systemic histoplasma capsulatum
fever, weight loss, hepatomegaly, spleenomegaly, lymphadenopathy
How do you detect histoplasma capsulatum?
1) antigen detection in serum, urine, and CSF: sensitive to systemic disease and therapy monitoring.
2)Antibody detection: IgM= acute, IgG= current or chronic. >75% in endemic areas (IgG)
3) Fungal stains are not very useful. detect fungal stage
4) Fungal culture: chronic and systemic. Takes 1-3 weeks.
What is the treatment for histoplasma capsulatum
mild to moderate: itranconazole for at least 12 months
Severe: amphotericin B for 2 weeks, then itranconazole for 12 months. Consider prophylaxis for HIV patients with CD4 < 150.
Describe coccidiodes immitis
endemic to the desert southwestern US. Those who are at risk include >65 years, immunosuppressed, pregnancy, ethnic: filipino, african american, native american, hispanic, asian. The disease state and progression is similar to histoplasmosis. IgG provides life long immunity.
Does IgG antibody provide lifelong immunity for coccidiodes immitis?
What does antibody detection for coccidiodes immitis tell you?
IgM= acute infection
If found in CSF= meningitis.
What will a fungal stain of coccidiodes immitis show?
what will a fungal culture of coccidiodes immitis show?
growth takes around 2-4 days. useful for chronic and systemic disease.
what is systemic dimorphic serology cross-reactivity?
looking for patient antibody to a specific fungal infection. There is cross-reactivity between systemic dimorphic organisms.